Healthcare Provider Details

I. General information

NPI: 1871718452
Provider Name (Legal Business Name): FISCHL DENTAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 CHURCH STREET SUITE 200W
EVANSTON IL
60201-4578
US

IV. Provider business mailing address

636 CHURCH STREET SUITE 200W
EVANSTON IL
60201-4578
US

V. Phone/Fax

Practice location:
  • Phone: 847-864-0822
  • Fax: 847-864-9799
Mailing address:
  • Phone: 847-864-0822
  • Fax: 847-864-9799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number060006229 020004357
License Number StateIL

VIII. Authorized Official

Name: PAUL L FISCHL
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 847-864-0822